talar fracture - very shortcme.uthscsa.edu/update/presentations/thursday/talar...• avn may be...
TRANSCRIPT
-
44THTH ANNUALANNUALEX FIX SYMPOSIUMEX FIX SYMPOSIUM
CONSIDERATIONSCONSIDERATIONS
1. FORCED DORSIFLEXIONOF TALUS?INVERSIONCANTILEVER
2. BLOOD SUPPLY3. BIOMECHANICS
4th Annual International External Fixation Symposium
December 11-14, 2008
1
-
HAWKINSHAWKINSCLASSIFICATIONCLASSIFICATION
GROUP/TYPE IGROUP/TYPE IIGROUP/TYPE IIIGROUP/TYPE IV*
FAST ROPING INJURYFAST ROPING INJURYTYPE II FX ?TYPE II FX ?
4th Annual International External Fixation Symposium
December 11-14, 2008
2
-
REALLY REALLY TYPE IVTYPE IV
MEDIAL MEDIAL APPROACHAPPROACH
4th Annual International External Fixation Symposium
December 11-14, 2008
3
-
LATERAL LATERAL APPROACHAPPROACH
POSTPOST--OPOPXX--RAYRAY
4th Annual International External Fixation Symposium
December 11-14, 2008
4
-
MOTORCYCLE ACCIDENTMOTORCYCLE ACCIDENTTYPE I ?TYPE I ?
REALLY TYPE IIREALLY TYPE II
4th Annual International External Fixation Symposium
December 11-14, 2008
5
-
POSTPOST--OPOP
WHEREWHERE’’SSTHE FX ?THE FX ?
4th Annual International External Fixation Symposium
December 11-14, 2008
6
-
ANKLE/SUBTALARANKLE/SUBTALARDISLOCATIONDISLOCATION
CT SCANCT SCAN
4th Annual International External Fixation Symposium
December 11-14, 2008
7
-
SCREWS THROUGHSCREWS THROUGHTALAR HEADTALAR HEAD
POSTPOST--OPOP
4th Annual International External Fixation Symposium
December 11-14, 2008
8
-
THAT HADTHAT HADTOO HURTTOO HURT
WHAT LOOKSWHAT LOOKSWORSE?WORSE?
4th Annual International External Fixation Symposium
December 11-14, 2008
9
-
ARTICULARARTICULARDAMAGEDAMAGE
POSTPOST--OPOP
4th Annual International External Fixation Symposium
December 11-14, 2008
10
-
HERE WEHERE WEGO AGAINGO AGAIN
MEDIALMEDIALCOMMINUTIONCOMMINUTION
4th Annual International External Fixation Symposium
December 11-14, 2008
11
-
MEDIAL TALARMEDIAL TALARPLATEPLATE
TALARTALARPLATINGPLATING
4th Annual International External Fixation Symposium
December 11-14, 2008
12
-
VASCULARITYVASCULARITYAVNAVN
WHAT DOWHAT DOI DO WITH AVN!I DO WITH AVN!
• AVN DOES NOT NECESSARILY COMPROMISE RESULT
• AVN MAY BE PARTIAL OR COMPLETE• COLLAPSE IS NOT ENVITABLE• COMFORT: 12 AVN ONLY ONE COLLAPSE• TX: IMMOBILIZATION & NWB• HOW LONG NWB? ART OF SURGERY!• BORNER 6 M/VECSEI 1 Y/KAZR 1.5 YS• TAKES 3 YRS TO REVASCULARIZE• EVALUATION: BONE SCAN/MRI
4th Annual International External Fixation Symposium
December 11-14, 2008
13
-
REAL PROBLEMREAL PROBLEMARTHRITISARTHRITIS
•• GROB ET AL.GROB ET AL.STJ 37% & ANKLE 32%
•• MINDELL ET AL.MINDELL ET AL.STJ 75%
•• PEENELPEENELSTJ 60% IN T-III FX
•• SZYSKOWITZ ET AL. SZYSKOWITZ ET AL. –– 69 PTS69 PTSSTJ 39 PTS AND ANKLE 38 PTS
•• FRAWLEY ET AL. FRAWLEY ET AL. –– 20 PTS20 PTSSTJ 16 PTS & ANKLE 4 PTS
NOT GOODNOT GOOD
4th Annual International External Fixation Symposium
December 11-14, 2008
14
-
WISH I WISH I DIDNDIDN’’T LOOKT LOOK
ABSORABLEABSORABLESCREWSCREW
4th Annual International External Fixation Symposium
December 11-14, 2008
15
-
APPEARS PRETTYAPPEARS PRETTYDAMN GOODDAMN GOOD
MULTIPLE FXMULTIPLE FX
4th Annual International External Fixation Symposium
December 11-14, 2008
16
-
MULTIPLE FXMULTIPLE FX
CT SCANCT SCAN
4th Annual International External Fixation Symposium
December 11-14, 2008
17
-
MEDIAL MALLEOLARMEDIAL MALLEOLAROSTEOTOMYOSTEOTOMY
POSTPOST--OPOP
4th Annual International External Fixation Symposium
December 11-14, 2008
18
-
TALAR BODY FXTALAR BODY FXPILON FXPILON FX
COMMINUTEDCOMMINUTEDTALAR BODY FXTALAR BODY FX
4th Annual International External Fixation Symposium
December 11-14, 2008
19
-
MODIFIEDMODIFIEDBLAIR FUSIONBLAIR FUSION
LATE SALVAGELATE SALVAGEARTHRODESISARTHRODESIS
4th Annual International External Fixation Symposium
December 11-14, 2008
20
-
DISTRACTIONDISTRACTIONARTHRODESISARTHRODESIS
OPEN TYPE IIIOPEN TYPE III
4th Annual International External Fixation Symposium
December 11-14, 2008
21
-
CONFUSEDCONFUSED
YOU’RE # 1
4th Annual International External Fixation Symposium
December 11-14, 2008
22
-
POSTERIORPOSTERIORSCREW FIXATIONSCREW FIXATION
FRACTURESFRACTURESGOING EVERYWHEREGOING EVERYWHERE
4th Annual International External Fixation Symposium
December 11-14, 2008
23